Journal of Health, Population, and Nutrition最新文献

Background: Noncommunicable diseases (NCDs) are complex and chronic in nature, often requiring long-term follow-up and care, which can lead to increased healthcare costs. This study aimed to evaluate health-seeking behavior and out-of-pocket healthcare expenditures for NCDs among patients in Erbil, Iraq.

Methods: This cross-sectional study involved a convenience sample of adult patients with NCDs visiting a private internal medicine center in Erbil City. A questionnaire was used to collect data on sociodemographic characteristics, NCD characteristics, health-seeking behavior, and the average monthly cost of NCDs. Multiple quantile regression analysis was performed to examine the variables associated with the total cost.

Results: Most participants get their NCD medicines from private pharmacies through out-of-pocket payments (96.0%). The median (IQR) cost of medications for NCDs per month was 70,000 (35,000-125,000) Iraqi Dinars (IQD), i.e., approximately US$48.3 (24.1-86.2). The median total out-of-pocket expenditures for all aspects of NCDs was 106,000 (60,000-184,500) IQD, i.e., approximately US$73.1 (41.4-126.9). Most participants indicated that out-of-pocket expenses for NCD treatment constitute an important financial burden on their households (74.4%). The total out-of-pocket expenditure for NCDs per month was statistically significantly higher among older age group (P < 0.001), those with no formal education (P = 0.002), those not working or with manual work (P = 0.003), those have more NCDs (P < 0.001), those with cardiovascular diseases (P < 0.001), those who get their medications from the private sector, those with better control of their NCDs (P = 0.002), those with complications of NCDs (P < 0.001), and those with good adherence (P = 0.001).

Conclusion: This study reveals the significant financial burden caused by out-of-pocket expenditures for NCD care. As most individuals with NCDs rely on private pharmacies for medication, the associated costs, particularly for those managing multiple conditions, represent a substantial challenge for households. There is a need for improved financial protection mechanisms and expanded access to affordable NCD care. Future research should examine the impact of health insurance coverage and public-sector interventions on reducing out-of-pocket expenditures and improving access to NCD care in Iraq.

Background: Chronic diseases pose significant global health burdens, necessitating robust biomarkers for early detection. The remnant cholesterol inflammatory index (RCII), integrating lipid remnants and systemic inflammation, may predict chronic disease risk, but its longitudinal associations remain understudied across diverse populations.

Methods: We analyzed data from two prospective cohorts-the China Health and Retirement Longitudinal Study (CHARLS, N = 9,491) and the English Longitudinal Study of Ageing (ELSA, N = 6,054)-to evaluate associations between baseline RCII and new-onset chronic diseases. RCII was calculated as (remnant cholesterol × hsCRP)/10. Cox models estimated hazard ratios (HRs) for incident diseases, adjusting for sociodemographic, metabolic, and comorbidity covariates.

Results: In CHARLS, each unit increase in logarithm-transformed RCII (lnRCII) was associated with higher diabetes risk (HR = 1.09, 95% CI: 1.02-1.15). In ELSA, elevated lnRCII was associated with multiple outcomes, including diabetes (HR = 1.13, 95% CI: 1.01-1.27), stroke (HR = 1.26, 95% CI: 1.15-1.38), psychiatric disease (HR = 1.16, 95% CI: 1.03-1.30), asthma (HR = 1.27, 95% CI: 1.11-1.46), and COPD (HR = 1.36, 95% CI: 1.01-1.51). Associations for hypertension and heart disease were significant in unadjusted models but no longer significant after adjustment.

Conclusion: RCII shows a consistent association with incident diabetes across both Chinese and UK cohorts, whereas its relationships with other chronic diseases were observed only in the UK cohort. These findings suggest that RCII may serve as a robust marker for diabetes risk and a broader indicator of multisystem vulnerability in certain populations, warranting cautious interpretation and further validation.

Objective: This study aimed to comprehensively examine the association between the ZJU index and the risk of developing cardiometabolic multimorbidity (CMM) among middle-aged and older Chinese adults.

Methods: Utilizing data from the Guizhou sub-cohort of the REACTION study, the ZJU index was derived by integrating key metrics, including body mass index (BMI), fasting plasma glucose (FPG), triglycerides (TG), and the alanine aminotransferase to aspartate aminotransferase ratio (ALT/AST). A total of 8,797 participants aged 40 and older were monitored over an average duration of 10.05 years, with 6,854 individuals (77.9%) included in the final analysis. Participants were categorized into quartiles based on their initial ZJU Index levels. To evaluate independent associations, multivariable logistic regression was employed; restricted cubic splines (RCS) were used to illustrate dose-response relationships, and recursive algorithms were applied to determine risk thresholds. The predictive accuracy of the ZJU index was compared with traditional single indicators using receiver operating characteristic (ROC) curves.

Result: Throughout the follow-up period, 381 new cases of CMM were recorded. After controlling for confounding variables, a linear positive relationship was observed between the ZJU index and CMM risk (P for non-linearity > 0.05). The highest quartile (Q4) exhibited a 2.29-fold increase in the risk of CMM (95% CI: 1.42-3.70) compared to the lowest quartile (Q1). The area under the ROC curve (AUC) for the ZJU index in predicting CMM was 0.651 (95% CI: 0.623-0.678), significantly outperforming the predictive capabilities of BMI, FPG, TG, and the ALT/AST ratio individually. Subgroup analyses revealed that this relationship remained consistent across various categories defined by sex, age, BMI, smoking status, and drinking status, with no significant interactions detected.

Conclusion: The ZJU index serves as an independent risk factor for CMM. Its straightforward calculation and excellent predictive ability make it highly suitable for early screening and risk assessment in community settings.

Background: Exclusive breastfeeding (EBF) is essential for optimal infant nutrition and health, yet its uptake remains suboptimal in Nigeria. Although the Accelerating Nutrition Results in Nigeria (ANRiN) project delivers community-based nutritional interventions, there is limited evidence on how access to the intervention influenced mothers' knowledge, attitudes, and practices (KAP) regarding EBF, particularly in Kwara State.

Objectives: This study assessed the KAP of EBF among mothers of infants aged 0-6 months in Kwara State and identified the sociodemographic predictors associated with these outcomes with access to ANRiN intervention as a comparator.

Methods: A descriptive cross-sectional study was conducted among 582 mothers of infants aged 0-6 months (with access to ANRiN intervention as a comparator into beneficiaries and non-beneficiaries), recruited using multistage sampling. Data were collected with a structured questionnaire and analyzed using chi-square tests, t-tests, and logistic regression.

Results: Beneficiaries demonstrated significantly higher knowledge (10.65 ± 2.49 vs. 8.98 ± 2.69, p < 0.001) and attitude scores (5.52 ± 0.91 vs. 5.32 ± 1.13, p = 0.024) than non-beneficiaries. The prevalence of breastfeeding in the previous 24 h was also higher among beneficiaries (56.6%) compared to non-beneficiaries (43.4%, p = 0.012), though this does not necessarily reflect sustained EBF for six months. Predictors of good knowledge and attitudes differed between groups: for non-beneficiaries, partner education (p = 0.013, p = 0.009), higher income (p = 0.010), and healthcare provider information (p = 0.002) were significant, whereas among beneficiaries, urban residence (p = 0.002), self-employment (p = 0.023), and healthcare provider information (p < 0.001) were strongest. Improved practices among beneficiaries were associated with higher partner education (p = 0.048) and employment (p = 0.001, p = 0.015).

Conclusions: The findings show that nutritional interventions such as ANRiN not only enhance mothers' EBF knowledge and attitudes but also shape distinct predictors of practice compared to non-beneficiaries. Tailored strategies that consider these differential predictors, such as targeting rural, less-educated households for non-beneficiaries and addressing urban-rural disparities among beneficiaries, may strengthen the effectiveness of EBF promotion programs in Nigeria.

Diarrheal disease is the second leading cause of death in under-five children. This study assessed the prevalence and risk factors of diarrhea among under-five Indonesian children using data from the 2017 Indonesia Demography and Health Survey.The analysis included 17,263 children living with their mothers and was based on a multistage stratified sampling design. Diarrhea was defined as maternal report of an episode within the two weeks preceding the survey. Descriptive statistics and chi-square tests were used for preliminary analysis. Determinants of diarrhea were examined using mixed-effects multilevel Poisson regression to account for the hierarchical data structure, with region specified as a random effect. All analyses were conducted using Stata. The model included region as a random effect, allowing baseline diarrhea prevalence to vary across regions. Female children had a lower prevalence of diarrhea than males (APR = 0.883; 95%CI:0.815-0.956), while children aged 1-2 years had a higher prevalence compared with infants. Higher household wealth was strongly protective, with children from the richest households showing a substantially lower prevalence (APR = 0.720; 95%CI:0.611-0.812). Environmental factors remained significant in the multilevel framework, as households with standard sanitation facilities had lower diarrhea prevalence (APR = 0.871; 95%CI:0.776-0.976), and rural residence was associated with higher prevalence. The small random-effect variance indicated limited residual regional heterogeneity after adjustment. Childhood diarrhea in Indonesia is shaped by interacting individual, environmental, and community-level factors. Socioeconomic disadvantage and inadequate sanitation remain major contributors to diarrhea prevalence among under-five children. The limited residual regional variation suggests that improvements in household living conditions and sanitation, particularly in rural areas, could substantially reduce disease burden. Multilevel analytical approaches are crucial for informing targeted and effective public health interventions.

Background: In Turkey, free vitamin D drop supplementation is provided during the first 12 months after birth. This study aimed to investigate the effectiveness of the National Vitamin D Supplementation Program among children aged 0-12 months in the Karabük province.

Methods: The study examined the vitamin D levels of children aged 0-36 months. Data were collected to assess the prevalence of vitamin D deficiency and sufficiency within the age intervals of 0-12, 12-24, and 24-36 months.

Results: The findings revealed that the majority of children fail to attain the desired vitamin D levels. While only one-fourth of the patients attained adequate vitamin D levels within the first 12 months, this proportion progressively declined to one-tenth as they approached the 36th month.

Conclusion and recommendation: Reforms are necessary in the current strategy for vitamin D supplementation, which is provided free of charge before the age of one. To enhance the effectiveness of the program, healthcare providers in primary care settings should play a central role. The new strategy should focus on a thorough explanation and, in particular, the implementation of a control mechanism. Such a mechanism can ensure oversight by encouraging reminders.

Background: This study assessed the relationship between HFCS and knowledge, attitudes, and practices of vitamin A, iron, and iodine among nutritionally vulnerable households within Ethiopia's industrial area.

Methods: A community-based, cross-sectional study was conducted using structured interviews and food frequency questions. The association between KAP variables and HFCS was assessed by ordered logit regression, controlling demographic and socio-economic factors. The study took place in three of the most densely populated and industrially active districts of Akaki-Kaliti Sub-City, Addis Ababa, Ethiopia.

Results: In all, 504 nutritionally vulnerable households containing at least one under-five child, pregnant, or lactating woman were interviewed, of which the majority were male-headed and married. Only 23.5% of households had an acceptable HFCS, mainly cereal- and tuber-based diets with very low fruit and vegetable consumption. Mean household wealth index was low at 0.33, with one-quarter of household heads and mothers being unemployed. Overall KAP scores were not significantly related to HFCS, but certain micronutrient practices were strongly positively related to vitamin A and iron intakes. Vitamin A knowledge and attitude also showed a significant positive association with higher HFCS, while iodine-related attitude was negatively associated. Higher education level and household wealth were positively associated with acceptable HFCS. Older maternal age was inversely associated, while household size showed mixed effects, being negative in the overall model and positively associated with acceptable HFCS in the nutrient-specific models for iron and vitamin A. Households having a pregnant woman and those from highly urbanized districts had higher odds of having acceptable HFCS. Although there was a widespread use of iodized salt, knowledge on the three micronutrients remained poor, with only 2.2% of the households showing good knowledge in all categories.

Conclusion: Dietary quality among households was generally low and closely associated with socioeconomic status and specific micronutrient practices. Improving education and household economic capacity could enhance nutritional outcomes, particularly among larger households and older mothers. Nutrition programs should prioritize promoting micronutrient-related behaviors and addressing socioeconomic and spatial disparities across urban districts.

Background: Diet low in vegetables and fruits is one of the leading dietary risk factors for non-communicable diseases. In Hungary, the average consumption of vegetables and fruits is less than the recommended daily amount. Home gardening is a feasible option in rural areas and could provide a sustainable way to increase daily vegetable and fruit intake. This study evaluated the effect of a home gardening intervention on vegetable and fruit consumption in two rural settlements in Hungary.

Methods: A pre-post interventional study was conducted between May and September 2022 with the participation of 50 adults. The intervention included education on gardening, nutrition and healthy cooking techniques. The participants were provided with seeds and seedlings, and an information booklet. Before and after the intervention a questionnaire was used to collect information on sociodemographic data, vegetable and fruit consumption, knowledge of healthy diet, physical activity, weight and height, and wellbeing. The differences between vegetable and fruit consumption, and other variables measured before and after the intervention were tested using statistical tests.

Results: The consumption of fruits and vegetables increased from a median of 1.6 (IQR 0.8-2.7) servings to 5.5 (IQR 3.9-7.6) servings per day (p < 0.001). The proportion of participants meeting the recommended intake of at least 5 servings per day increased from 10% to 60% (p < 0.001). Nutrition knowledge and physical activity slightly improved (p < 0.001), while BMI did not significantly change.

Conclusion: The complex home gardening intervention had a positive effect on the vegetable and fruit intake of the study participants. Home gardening is potentially a feasible way of promoting healthier eating habits in rural communities.

The aim of this research was to objectively assess the effectiveness of the traditional drinking cure using Karlovy Vary mineral springs, focusing on the quantitative measurement of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), through the determination of liver elasticity before and after a 21-day course of therapy. The study included randomly selected subjects from the Karlovy Vary population, aiming to scientifically validate the health benefits associated with this long-standing therapeutic practice, particularly with respect to metabolic health and liver function.